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I am a case manager in a hospital and I am unable to get clarification on this issue.

JoAnn makes a very good point in the second paragraph of her response. 

Someone in the hospital, at the managerial level, or in the legal counsel's office, should be advising you on this, b/c it could affect the hospital at many levels, and you certainly don't want to be responsible if the hospital isn't able to provide an answer.

In my opinion, this is a question that should be posed by a hospital manager (and that could be you) to either a higher level manager or directly to Medicare.   The fact that you haven't gotten clarification (presumably in house/hospital) makes me think higher management isn't certain either.

I would ask legal counsel or a higher up administrator to raise this question directly with Medicare.    Get yourself out of the decision making queue.  

Is this a small hospital, in a small area?
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I guess anyone can file an appeal doesn't mean they will win. If Medicare felt it was time for the person to be discharged then they get discharged. Looks like they were sending the patient to a hospital rehab so their care would be better than just going to a rehab.

As a case manager can u not contact Medicare directly and run it by them? You are asking layman here unless one our members has done ur job. I know we have some Social Workers.

I have found with some of our posters that they have no idea how Medicare works. Reason is they have never dealt with it. Also, regular insurance policies. Both have the right to stop care if they feel the person no long needs the care.
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needtowashhair Feb 6, 2020
Generally, it's not medicare that "feels" anything. It's the facility. That's a common misconception when someone gets a notice. They think it's a medicare determination. It's not. Read it carefully. It's the facility determining that it's concerned that medicare may not pay. So it's being preemptive by getting rid of you.

When filing appeals, it's not until the third appeal that you get medicare's take on it. The first two appeals are with another private health care corporation. That third appeal is with a medicare employee or a judge.
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